Prolonged Survival in a Patient with Idiopathic Pulmonary Fibrosis Receiving Acupuncture and DHEA-Promoting Herbs with Conventional Management: A Case Report.
DISCUSSION: Studies exist linking dehydroepiandrosterone with IPF disease activity as well as acupuncture with antifibrotic activity. Larger clinical studies are needed to substantiate the link between acupuncture and/or dehydroepiandrosterone-stimulating herbs for the treatment of IPF. PMID: 30624191 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Westernized Diet is the Most Ubiquitous Environmental Factor in Inflammatory Bowel Disease.
Authors: Chiba M, Nakane K, Komatsu M Abstract Inflammatory bowel disease (IBD), a collective term for Crohn disease and ulcerative colitis, is a polygenic disease thought to be triggered by environmental factors. A Western or westernized lifestyle may be a major driver of the growing incidence of IBD. IBD may represent dysregulated mucosal inflammation to gut microbiota. Despite many review articles on environmental factors in IBD, no consensus exists regarding which factor contributes most to trigger the onset of IBD. Identification and recognition of major environmental factors are prerequisite for effective dis...
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Health Appraisal and the Adverse Childhood Experiences Study: National Implications for Health Care, Cost, and Utilization.
This article describes the origins of the Division of Health Appraisal in Southern California Permanente Medical Group's San Diego Department of Preventive Medicine, which provided a comprehensive and nontraditional array of preventive medicine services to more than 50,000 members a year. The fusion of Health Appraisal with the Positive Choice risk abatement services provided the origins of the now internationally recognized Adverse Childhood Experiences Study and its major implications for the outcomes and costs of medical care.The Health Appraisal system fulfilled the medical evaluation and preventive needs of most adult...
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Cannabidiol in Anxiety and Sleep: A Large Case Series.
CONCLUSION: Cannabidiol may hold benefit for anxiety-related disorders. Controlled clinical studies are needed. PMID: 30624194 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Development of an Intervention to Reduce Pain and Prevent Syncope Related to Adolescent Vaccination.
CONCLUSION: Patients, parents, and clinicians acknowledged the value of interventions to reduce pain and syncope after adolescent vaccination. Stakeholders identified a comfort menu as the intervention to be piloted at 2 KPNW pediatric clinics. Further research is needed to test the effectiveness of the "Vaccination Comfort Menu" intervention in improving vaccination experiences and continued receipt of vaccinations. PMID: 30624195 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Effects of a Group Protocol on Physical Activity and Associated Changes in Mood and Health Locus of Control in Adults with Parkinson Disease and Reduced Mobility.
CONCLUSION: The intervention demonstrated positive effects on physical activity and psychosocial factors in adults with PD and with reduced mobility. Effects on social cohesion were important. Such programming should be considered as an adjunct to traditional medical treatment. PMID: 30624196 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Utility of Human Epidermal Growth Factor Receptor 2 (HER2) Retesting of Histologic Grade 3 Invasive Breast Carcinomas.
CONCLUSION: The rate of clinically significant HER2 status discordance between core biopsy and surgical specimens in patients with Grade 3 breast carcinoma is low. However, given the dramatically improved survival conferred by trastuzumab therapy, our findings support reflex HER2 testing of surgical specimens for patients with core biopsy-diagnosed HER2-negative breast carcinoma. PMID: 30624197 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Patient Education and Pharmacist Consultation Influence on Nonbenzodiazepine Sedative Medication Deprescribing Success for Older Adults.
CONCLUSION: Patients who received direct-to-patient education with or without a pharmacist consultation were significantly more likely to discontinue Z-drug use than patients receiving UC. Providing evidence-based information about Z-drug use is an effective and low-resource method to encourage drug discontinuation. PMID: 30624198 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Neutrophil:Lymphocyte Ratio as a Predictive Factor for Success of Nephron-Sparing Procedures in Patients with Emphysematous Pyelonephritis.
CONCLUSION: NLR is a useful predictive marker in emphysematous pyelonephritis. Its predictive value increases when combined with presence or absence of ARF. In patients with high NLR and ARF, the threshold for considering nephrectomy should be low. PMID: 30624199 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Acute Influenza Infection Presenting with Cardiac Tamponade: A Case Report and Review of Literature.
We present a case of a 57-year-old man with acute influenza infection complicated by pericardial effusion and cardiac tamponade. CASE PRESENTATION: A 57-year-old white man presented to the Emergency Department with sudden onset of severe, nonexertional, retrosternal, pressure-like chest pain for a few hours and with fever and muscle aches for 2 days. The patient was initially admitted because of suspected acute coronary syndrome. The next morning, he complained of acute-onset shortness of breath and had hypotension and tachycardia. On examination, his peripheral extremities were cold and heart sounds were distant. Puls...
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Image Diagnosis: Aortic Thrombus in Severe Hypercortisolemia.
Authors: Lowry M, Achanta L PMID: 30624201 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Melanosis Coli: A Case of Mistaken Identity-A Case Report.
DISCUSSION: Melanosis coli is a diagnostic finding that can easily be confused with bowel ischemia, which may create a dilemma for the surgeon who is attempting to make a decision regarding the extent of a colonic resection. As such, a pathology consult is warranted in any patient with suspected ischemic colitis and concerns for concomitant melanosis coli. PMID: 30624202 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Trend of Surgical Treatment of Localized Renal Cell Carcinoma.
Authors: Jabaji RB, Fischer H, Kern T, Chien GW Abstract INTRODUCTION: Rapid adoption of robotics has introduced a paradigm change in prostate cancer treatment, with more than 80% of prostatectomies performed robotically in 2015. For treatment of renal cell carcinoma (RCC), this change has not previously been reported. We evaluated trends in surgical management of RCC in Kaiser Permanente Southern California (KPSC) within the last 16 years, especially after adoption of robotics. METHODS: From January 1999 to September 2015, all KPSC members who underwent surgical treatment of suspected RCC were included retrosp...
Source: The Permanente journal - January 10, 2019 Category: General Medicine Tags: Perm J Source Type: research

Association of Adverse Childhood Experiences with Depression in Latino Migrants Residing in Tijuana, Mexico.
CONCLUSION: Among Latino migrants residing in the US-Mexico border region, ACEs were pervasive and associated with depression symptoms. Programs and policies targeting migrants in this region should consider addressing both ACEs and depression. PMID: 30589403 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 29, 2018 Category: General Medicine Tags: Perm J Source Type: research

Two Poems.
Authors: Mclean A PMID: 30589404 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 29, 2018 Category: General Medicine Tags: Perm J Source Type: research

Is There a Lack of Support for Whole-Food, Plant-Based Diets in the Medical Community?
Authors: Storz MA Abstract Since the early 2000s, plant-based nutrition has increased in popularity in the general population. Kaiser Permanente significantly contributes to this development by promoting plant-based diets and by continuously incorporating plant-based nutrition on the front lines with their dietary recommendations. Despite a continuously growing body of evidence and the meticulous work of renowned experts in this field worldwide, the latest findings in this area have not found their way into US national dietetic guidelines.We must ask ourselves why this is the case, given the numerous advantages and...
Source: The Permanente journal - December 29, 2018 Category: General Medicine Tags: Perm J Source Type: research

Image Diagnosis: Thoracic Epidural Hematoma from a Fall Requiring Emergent Decompressive Laminectomy and Hematoma Evacuation.
Authors: Viswanath O, Yazdi C PMID: 30589406 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 29, 2018 Category: General Medicine Tags: Perm J Source Type: research

Long-Term Tumor-Free Survival in a Patient with Stage IV Epithelial Ovarian Cancer Undergoing High-Dose Chemotherapy and Viscum album Extract Treatment: A Case Report.
DISCUSSION: Treatment with VAE in this case might have contributed to the reduction of side effects from HDC and may have acted synergistically with HDC in tumor control. Cases of VAE in EOC should be carefully documented and reported to further illustrate the influence of VAE on this cancer presentation. PMID: 30589407 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 29, 2018 Category: General Medicine Tags: Perm J Source Type: research

My Father's Dying.
Authors: Malpas P Abstract The monarch butterflies so abundant around the small pond are slowly disappearing. Tomatoes from the vine that curled its way up the drainage spout are now lined up on the kitchen windowsill to capture the sun's rays. Summer draws to an end as my father's life also draws to a close.As part of my narrative, I have included, in italics, entries from my journal from this time. PMID: 30589408 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 29, 2018 Category: General Medicine Tags: Perm J Source Type: research

Image Diagnosis: Esophageal Intramural Hematoma in Sudden-Onset Chest Pain and Dysphagia.
Authors: Mandavdhare HS, Gupta P, Maity P, Sharma V PMID: 30589409 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - December 29, 2018 Category: General Medicine Tags: Perm J Source Type: research

The Importance of Continual Learning in a Rapidly Changing Health Care Environment.
Authors: Kanter MH, Courneya PT PMID: 30414625 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - November 13, 2018 Category: General Medicine Tags: Perm J Source Type: research

Relationship Between Adverse Childhood Experience Survey Items and Psychiatric Disorders.
Authors: Cawthorpe D, Marriott B, Paget J, Moulai I, Cheung S Abstract CONTEXT: Developmental psychopathology theory suggests a relationship between early childhood adversity and mental disorder. OBJECTIVE: To examine the relationship between the specific items on the Adverse Childhood Experiences (ACE) survey and the International Classification of Diseases, Tenth Revision (ICD-10) categories of psychiatric diagnoses in a pediatric sample. DESIGN: The sample included patients enrolled in the Child and Adolescent Addiction Mental Health and Psychiatry Program with both a completed ACE survey and at least 1 ...
Source: The Permanente journal - October 10, 2018 Category: General Medicine Tags: Perm J Source Type: research

Universal Screening for Social Needs in a Primary Care Clinic: A Quality Improvement Approach Using the Your Current Life Situation Survey.
CONCLUSION: By using a frontline improvement approach, these investigators could answer questions and address concerns most important to local operational stakeholders when implementing screening for social needs. When practitioners conduct universal social needs screening and more fully understand social needs prevalence in a primary care clinic, resources can be tailored more effectively to accommodate patient needs. PMID: 30296397 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - October 10, 2018 Category: General Medicine Tags: Perm J Source Type: research

Using Neighborhood-Level Census Data to Predict Diabetes Progression in Patients with Laboratory-Defined Prediabetes.
CONCLUSION: Area-level socioeconomic and food assistance data predict the development of diabetes, even after adjusting for traditional individual demographic and clinical factors. Clinical interventions should take these factors into account, and health care systems should consider addressing social needs and community resources as a path to improving health outcomes. PMID: 30296398 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - October 10, 2018 Category: General Medicine Tags: Perm J Source Type: research

Inadequate Clinical Indications in Computed Tomography Chest and Abdomen/Pelvis Scans.
CONCLUSION: The percentage of complete clinical indications for both CT chest and abdomen/pelvis scans was much lower than 50%, suggesting that more emphasis should be placed on providing complete clinical indications. PMID: 30296399 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - October 10, 2018 Category: General Medicine Tags: Perm J Source Type: research

Lessons Learned from Implementation of the Food Insecurity Screening and Referral Program at Kaiser Permanente Colorado.
This article describes barriers encountered and lessons learned from implementation and expansion of the Kaiser Permanente Colorado's clinical food insecurity screening and referral program, which operates in collaboration with a statewide organization (Hunger Free Colorado) to manage clinic-to-community referrals. The immediate goals of clinical screening interventions described in this article are to identify households experiencing food insecurity, to connect them to sustainable (federal) and emergency (community-based) food resources, to alleviate food insecurity, and to improve dietary quality. Additional goals are to...
Source: The Permanente journal - October 10, 2018 Category: General Medicine Tags: Perm J Source Type: research

Vidian Nerve Schwannoma: A Rare Skull-Base Neoplasm Presenting with Ocular Manifestations: A Case Report and Literature Review.
DISCUSSION: A literature review showed that this is the second reported case of a vidian nerve schwannoma presenting with ocular symptoms and that endoscopic resections are becoming the standard of care. Practitioners should be aware that vidian nerve schwannomas can present as a skull-base mass with predominantly ocular symptoms, including vision loss, secondary to mass effect. Consideration should be given to this entity in the setting of typical radiographic and histopathologic characteristics. Endoscopic approaches to resection are safe and have low morbidity. PMID: 30285912 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - October 5, 2018 Category: General Medicine Tags: Perm J Source Type: research

Sex-Based Differences in Symptom Perception and Care-Seeking Behavior in Acute Stroke.
CONCLUSION: This study suggests that there are sex-based differences in symptom perception and care-seeking behavior in acute ischemic stroke. PMID: 30285913 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - October 5, 2018 Category: General Medicine Tags: Perm J Source Type: research

Perceptions and Experience of Patients, Staff, and Clinicians with Social Needs Assessment.
CONCLUSION: Our findings support the continuing assessment of social needs at KP and identify issues that require attention as it expands. Assessment should not outpace organizational capacity to connect members with resources. Careful attention to communications is required because members may be uncertain or concerned about the purpose of the assessment and the dissemination of sensitive information. Messaging should assure members about data use and dissemination and what they can expect after screening. PMID: 30285914 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - October 5, 2018 Category: General Medicine Tags: Perm J Source Type: research

"Do You Really Need This Appointment?"
"Do You Really Need This Appointment?" Perm J. 2018 Oct 01;22: Authors: Abramson S PMID: 30285915 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - October 5, 2018 Category: General Medicine Tags: Perm J Source Type: research

Effect of an Electronic Alert on Targeted HIV Testing Among High-Risk Populations.
Authors: Hechter RC, Bider-Canfield Z, Towner W Abstract CONTEXT: Screening for HIV infection in medical settings remains suboptimal. OBJECTIVE: To examine the real-world effectiveness of an electronic clinician alert on the same-day HIV testing rate and early diagnosis in high-risk populations. DESIGN: We identified Kaiser Permanente Southern California Health Plan members aged 14 years or older who received tests for sexually transmitted infections. MAIN OUTCOME MEASURES: Encounter-based same-day HIV testing rate, positive test result rate, and CD4+ cell count and HIV viral load at diagnosis. RESU...
Source: The Permanente journal - October 5, 2018 Category: General Medicine Tags: Perm J Source Type: research

Cognitive Behavioral Therapy with Heart Rate Variability Biofeedback for Adults with Persistent Noncombat-Related Posttraumatic Stress Disorder.
Authors: Criswell SR, Sherman R, Krippner S Abstract OBJECTIVE: To test the effectiveness of a mental health therapy designed to reduce noncombat-related persistent posttraumatic stress disorder (PTSD) symptoms in 30 adult outpatients with a diagnosis of PTSD. The individual treatment offered modules to address PTSD nightmare distress, dissociation, general core skills, alterations in arousal and reactivity, avoidance, intrusion, and negative alternations in cognitions and mood. The therapeutic approach centered on cognitive behavioral therapy and heart rate variability biofeedback. METHODS: The study had 2 com...
Source: The Permanente journal - October 5, 2018 Category: General Medicine Tags: Perm J Source Type: research

Dnr.
DNR. Perm J. 2018 Oct 01;22: Authors: Livaudais F PMID: 30285918 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - October 5, 2018 Category: General Medicine Tags: Perm J Source Type: research

The Best Year of Angela's Life.
Authors: Sundar KR Abstract Using a patient story, this narrative demonstrates why health care organizations, specifically primary care clinics, should strive to identify and to address social needs. This story demonstrates how Kaiser Permanente Washington, by using community resource specialists, has empowered primary care clinics to address social needs in a health care setting to improve patient care and experience. PMID: 30285919 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - October 5, 2018 Category: General Medicine Tags: Perm J Source Type: research

Different Harm and Mortality in Critically Ill Medical vs Surgical Patients: Retrospective Analysis of Variation in Adverse Events in Different Intensive Care Units.
Authors: Park KU, Eichenhorn M, Digiovine B, Ritz J, Jordan J, Rubinfeld I Abstract BACKGROUND: Institutional harm reduction campaigns are essential in improving safe practice in critical care. Our institution embarked on an aggressive project to measure harm. We hypothesized that critically ill surgical patients were at increased risk of harm compared with medical intensive care patients. METHODS: Three years of administrative data for patients with at least 1 Intensive Care Unit day at an urban tertiary care center were assembled. Data were accessed from the Henry Ford Health System No Harm Campaign in Detroi...
Source: The Permanente journal - October 5, 2018 Category: General Medicine Tags: Perm J Source Type: research

Management of Hypertension on the Labor and Delivery Unit: Delivering Care in the Era of Protocols and Algorithms.
CONCLUSION: Labetalol treatment was appropriately initiated in many cases; however, protocol adherence could greatly improve. Potential factors affecting protocol compliance include shift changes, communication issues, and conflicting protocols. Institutions should review protocol compliance to improve care. PMID: 30227906 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - September 21, 2018 Category: General Medicine Tags: Perm J Source Type: research

Developing Community-Based Primary Health Care for Complex and Vulnerable Populations in the Vancouver Coastal Health Region: HealthConnection Clinic.
CONCLUSION: The study demonstrates how the Building Blocks approach can be adapted to operationalize high-performing primary care standards in settings serving complex and vulnerable populations. PMID: 30227907 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - September 21, 2018 Category: General Medicine Tags: Perm J Source Type: research

Image Diagnosis: Dysphagia Lusoria-An Unusual Cause of Dysphagia Diagnosed with Endoscopic Ultrasound.
Authors: Mandavdhare HS, Sharma V, Gupta P PMID: 30227908 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - September 21, 2018 Category: General Medicine Tags: Perm J Source Type: research

Spotlight on Antidiabetic Agents with Cardiovascular or Renoprotective Benefits.
Authors: Madievsky R Abstract Type 2 diabetes mellitus often goes hand in hand with cardiovascular and renal comorbidities. Stroke, myocardial infarction, heart failure, and chronic kidney disease are high-risk complications of type 2 diabetes that contribute to morbidity and mortality. Recent clinical trials have uncovered evidence that certain antidiabetic agents may confer cardiovascular and/or renal benefits such as reduced cardiovascular and all-cause mortality and reduced need for renal replacement therapy. Two landmark trials in particular, EMPA-REG OUTCOME (Empagliflozin, Cardiovascular Outcomes, and Mortal...
Source: The Permanente journal - September 21, 2018 Category: General Medicine Tags: Perm J Source Type: research

Contraception after Abortion and Risk of Repeated Unintended Pregnancy among Health Plan Members.
CONCLUSION: In response to this study, KPNC now provides reimbursement for LARC in all outside abortion contracts, internalized more abortions in KPNC facilities, and strengthened clinical recommendations for immediate, effective postabortion contraception, especially LARC. PMID: 30227910 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - September 21, 2018 Category: General Medicine Tags: Perm J Source Type: research

My Siren.
Authors: Battaglia A PMID: 30227911 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - September 21, 2018 Category: General Medicine Tags: Perm J Source Type: research

Uses and Misuses of Patient- and Neighborhood-level Social Determinants of Health Data.
Authors: Gottlieb LM, Francis DE, Beck AF Abstract Health care leaders in the US are actively exploring strategies to identify and address patients' social and economic hardships as part of high-quality clinical care. The result has been a proliferation of screening tools and interventions related to patients' social determinants of health, but little guidance on effective strategies to implement them. Some of these tools rely on patient- or household-level screening data collected from patients during medical encounters. Other tools rely on data available at the neighborhood-level that can be used to characterize ...
Source: The Permanente journal - September 21, 2018 Category: General Medicine Tags: Perm J Source Type: research

To Pace or Not To Pace? A Narrative Review of VIP Syndrome.
Authors: Khoo CS PMID: 30227913 [PubMed - as supplied by publisher] (Source: The Permanente journal)
Source: The Permanente journal - September 21, 2018 Category: General Medicine Tags: Perm J Source Type: research

Urate-Lowering Therapy in Moderate to Severe Chronic Kidney Disease.
Authors: Levy G, Shi JM, Cheetham TC, Rashid N Abstract CONTEXT: Hyperuricemia is an independent risk factor for progression of kidney disease. OBJECTIVE: To determine whether lowering serum uric acid level (sUA) to below 6 mg/dL (target) improves mild to moderate chronic kidney disease (CKD) and whether CKD stage influences the benefit of lowering sUA to target. DESIGN: Retrospective epidemiologic cohort study conducted over 8 years. Estimated glomerular filtration rate (eGFR) was required in the 6 months preceding the index date (defined as first occurrence of sUA
Source: The Permanente journal - September 13, 2018 Category: General Medicine Tags: Perm J Source Type: research

Clostridium Difficile-Associated Infection in Trauma Patients: Development of the Clostridium Difficile Influencing Factors (CDIF) Score.
Authors: Karamanos E, Gupta AH, Stanton CN, Mohamed A, Patton JH, Schmoekel N Abstract CONTEXT: Clostridium difficile-associated infection (CDAI) can result in longer hospitalization, increased morbidity, and higher mortality rates for surgical patients. The impact on trauma patients is unknown, however. OBJECTIVE: To assess the effect of CDAI on trauma patients and develop a scoring system to predict CDAI in that population. METHODS: Records of all trauma patients admitted to a Level I Trauma Center from 2001 to 2014 were retrospectively reviewed. Presence of CDAI was defined as evidence of positive toxin ...
Source: The Permanente journal - September 13, 2018 Category: General Medicine Tags: Perm J Source Type: research

Sensory Inattention.
Authors: Bakshi N PMID: 30201089 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - September 13, 2018 Category: General Medicine Tags: Perm J Source Type: research

"A" for Life.
"A" for Life. Perm J. 2018 Aug 30;22: Authors: Ahmed F, Ali SA Abstract This is a story of a medical intern whose cascade of baffling thoughts about pursuing a career finally led to a gratifying conclusion. This young intern is easily swayed by the opinions of others, but circumstances proved that the field he chose was the one he was made for. This is a story of determination and belief in one's ability, which gave the power to fight against the odds. PMID: 30201090 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - September 13, 2018 Category: General Medicine Tags: Perm J Source Type: research

Therapeutic Interferon Interchange in Relapsing Multiple Sclerosis Lowers Health Care and Pharmacy Expenditures with Comparable Safety.
Authors: Hahn N, Palmer KE, Klocke S, Delate T Abstract INTRODUCTION: For patients with a less-active (fewer relapses or complete recovery from relapses, less radiologic burden of disease, or no or limited disease-related disability) relapsing form of multiple sclerosis (MS), interferon (IFN) beta-1b subcutaneous is similar in efficacy to IFN beta-1a intramuscular and subcutaneous. The purpose of this study was to assess the impact of patient interchange from an IFN beta-1a to IFN beta-1b. METHODS: This was a retrospective, pre-post study of adult patients with relapsing MS who underwent interchange from an IFN...
Source: The Permanente journal - September 13, 2018 Category: General Medicine Tags: Perm J Source Type: research

Listening Beyond Auscultating: A Quality Initiative to Improve Communication Scores in the Hospital Consumer Assessment of Health Care Practitioners and Systems Survey.
CONCLUSION: Medical students used established improvement methods to promote patient-centered care and align patient and physician agendas, providing a strategy to improve hospitalized patients' perceptions of physician listening. PMID: 30028667 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - July 23, 2018 Category: General Medicine Tags: Perm J Source Type: research

Turbo Metabolism: 8 Weeks to a New You.
Authors: Elder CR PMID: 30028668 [PubMed - in process] (Source: The Permanente journal)
Source: The Permanente journal - July 23, 2018 Category: General Medicine Tags: Perm J Source Type: research